胱抑素C评估左心室射血分数保留的心力衰竭患者预后的价值  

Value of cystatin C for reviewing prognosis in heart failure patients with preserved left ventricular ejection fraction

作　　者：肖勇强[1] 蒋毅[1] 

机构地区：[1]自贡市第一人民医院心内科,四川643000

出　　处：《中国循证心血管医学杂志》2014年第6期754-757,共4页Chinese Journal of Evidence-Based Cardiovascular Medicine

基　　金：四川省医学会"施慧达"科研课题(编号:SHD11-20)

摘　　要：目的：探讨胱抑素C（Cys C）评估左心室射血分数保留的心力衰竭患者预后的价值。方法选取2012年06月至2012年12月自贡市第一人民医院心内科住院的急性心力衰竭或慢性心力衰竭（心衰）急性加重的心衰患者215例，其中男性107例，女性108例，年龄50-91岁。检测患者血肌酐、血尿素氮、血红蛋白、脑钠肽（BNP）和C-反应蛋白（CRP）水平，计算肾小球滤过率（eGFR）。记录住院期间以及出院后400 d内I级终点事件及全因死亡。所有患者按Cys C水平分为四组，A组（＜1.10 mg/L）54例，B组（1.10-1.47 mg/L）54例，C组（1.48-1.88 mg/L）54例，D组（＞1.88 mg/L）53例。结果与A组比较，C组和D组肾功能不全比例、BNP、血尿素氮水平、I级终点事件发生率和全因死亡率升高，eGFR下降，差异具有统计学意义（P均＜0.01）。与B组比较，C组和D组肾功能不全比例、BNP、血尿素氮水平升高，eGFR下降，差异具有统计学意义（P均＜0.01）。随着血清Cys C升高，血肌酐呈上升趋势，差异具有统计学意义（P均＜0.01）。血清Cys C和血肌酐呈显著正相关（r=0.717，P＜0.01），和eGFR呈明显负相关（r=-0.778，P＜0.01），与BNP呈显著正相关（r=0.530，P＜0.01）和心功能NYHA分级也有较强的相关性（r=0.504，P＜0.01），与CRP呈正相关（r=0.303，P＜0.01）。使用Kaplan-Meier生存曲线对四组的I级终点事件发生率和死亡率进行分析，随着血清Cys C的升高，HFPEF患者的I级终点事件发生率和死亡率均逐渐升高（P均＜0.01）当血清Cys C的诊断界值为1.54 mg/L的时候，ROC曲线下面积达到最大值，敏感性和特异性分别为72.97%和85.58%。使用ROC曲线评价BNP、血尿素氮、血肌酐、CRP对患者I级终点事件的预测价值，面积均小于血清Cys C（ROC曲线下面积分别为：0.7186、0.7143、0.7489、0.6138，P均〈0.001）。结论 Cys C评估左心室射血分数保留的�Objective To investigate the value of cystatin C （Cys-C） for reviewing prognosis in heart failure patients with preserved left ventricular ejection fraction （LVEF）.Methods The patients with acute heart failure （AHF） or acute exacerbated chronic heart failure （n=215, male 107, female 108 and aged from 50 to 91） were chosen from June 2012 to Dec. 2012. The levels of serum creatinine （SCr）, blood urea nitrogen （BUN）, hemoglobin （Hb）, brain natriuretic peptide （BNP） and C-reactive protein （CRP） were detected, and glomerular filtration rate （GFR） was calculated. The incidence of grade I endpoint events and all-cause mortality were recorded during hospitalization period and within 400 d after discharged from hospital. All patients were divided into 4 groups according to Cys-C level, including group A （〈1.10 mg/L,n=54）, group B （1.10-1.47 mg/L,n=54）, group C （1.48-1.88 mg/L,n=54） and group D （〉1.88 mg/L,n=53）.Results Compared with group A, the percentage of patients with renal insufficiency, BNP, BUN, grade I endpoint events and all-cause mortality increased, and GFR decreased in group C and group D （allP〈0.01）. Compared with group B, the percentage of patients with renal insufficiency, BNP and BUN increased, and GFR decreased in group C and group D （allP〈0.01）. As Cys C increased, SCr showed an increasing trend （allP〈0.01）. Cys C was positively correlated to SCr （r=0.717,P〈0.01）, negatively correlated to GFR （r=-0.778, P〈0.01）, positively correlated to BNP （r=0.530,P〈0.01）, correlated to NYHA grading （r=0.504,P〈0.01）, and positively correlated to CRP （r=0.303,P〈0.01）. The analysis on the incidence of grade I endpoint events and all-cause mortality with Kaplan-Meier survival curve in 4 groups showed that as the increase of Cys C, the incidence of grade I endpoint events and all-cause mortality increased gradually （allP〈0.01）. When the cut-off diagnosis value of Cys C was 1.54 mg/L, the area under ROC curve r

关 键 词：胱抑素C 左室射血分数保留的心力衰竭 B型脑钠肽 

分 类 号：R541.61[医药卫生—心血管疾病]